If you’re one of the eight women diagnosed with PMOS (previously known as PCOS), you may have heard your doctor talk about the importance of a good diet and regular exercise to manage your condition. But what does a PMOS-friendly diet look like…should you be cutting carbs completely or going gluten free?
These are the questions many of my clients diagnosed with PMOS have, and the answer is usually much simpler than most of them realise! In this blogpost we’ll be breaking down what PMOS is, separating the diet facts from fiction and giving you some simple strategies to consider.
What is PMOS?
It may look like word salad, but PMOS stands for polyendocrine metabolic ovarian syndrome. PMOS is a lifelong condition where there is an imbalance in hormones that influence metabolic and reproductive health. It is a complex condition that affects many aspects of health, both physical and mental.
The main criteria that forms a diagnosis of PMOS is:
- A history of irregular or absent periods
- High androgens (hyperandrogenism)
- Multiple immature ovarian follicles (fluid filled sacks)
What are androgens?
Androgens are hormones recognised as being primarily responsible for the development of male characteristics such as facial hair and oily (sebaceous) skin.
Insulin resistance and PMOS
Research shows that insulin resistance affects up to 85% of people living with PMOS. According to Jean Hailes, “insulin resistance may be a co-occurring condition of PMOS, a cause of PMOS or a result of PMOS.”
The Diet Connection
Evidence shows that simple dietary changes can improve symptoms of PMOS and help to manage insulin resistance. Let’s dive in.
Whilst there is no one-size fits all diet for PMOS, the Mediterranean Diet stands out as being an excellent evidence-based eating pattern that can help to improve cardiometabolic health, manage weight and reduce inflammation associated with PMOS.
The Mediterranean Diet is a traditional dietary pattern followed by people living in the Mediterranean, which includes Morocco, Tunisia, Egypt, Lebanon, Palestine, Greece, Italy and Spain. It is characterised by high intakes of healthy fats such as extra virgin olive oil, olives, nuts and seeds, and fatty fish; moderate intakes complex carbohydrates from wholegrains, legumes, fruit and dairy (making up about 40% of energy intakes); lots of fibre and antioxidants from fruits, vegetables and legumes; and moderate intakes of plant proteins from legumes, nuts and seeds in addition to fish, poultry, eggs, dairy and modest amounts of red meats.
Unlike many fad diets, the Mediterranean diet is a holistic eating pattern that includes choices from all core food groups. This is especially important, as unbalanced and restrictive diets can impact your nutrient status and increase your risk for nutrient deficiencies.
Here’s some practical nutrition tips to consider:
Swap refined carbohydrates for low GI (complex) versions.
Refined carbohydrates are low in fibre and quickly raise your blood sugar levels, resulting in the inevitable insulin spike which can increase fat storage if you have insulin resistance. If you have insulin resistance, it is preferable to choose low GI (complex) carbs which are higher in fibre, as this slows down the absorption of sugar into the blood stream, giving you longer lasting energy throughout the day, increasing your feelings of fullness to prevent over-eating and reducing insulin output which over time can help to improve insulin sensitivity and metabolic health.
Consider swapping your usual white or wholemeal bread for a seedy multigrain bread such as Burgen Wholemeal and Seeds, or instead of peeling your potatoes could you leave the skins on? Or why not make a minestrone soup with wholemeal or pulse pasta and beans?
Increase your intakes of plant proteins.
Research shows that people who have higher intakes of plant proteins such as tofu, tempeh, beans and legumes generally have better metabolic health outcomes. Wholefood plant proteins are naturally low in saturated fats, and are a great source of fibre which can help to support heart and gut health.
Why not try a meatless Monday or vego Fri-yay (tofu pad thai anyone?)! Or could you substitute half of the meat in your spaghetti bolognese for some lentils or textured vegetable protein?
Enjoy a handful of nuts or seeds daily
Nuts are a fantastic source of healthy fats, fibre and vitamins such as vitamin E. Research shows that people who eat nuts regularly generally have better cardiometabolic health, and stable weight. In addition to this evidence shows that walnuts in particular may be a good inclusion in a PMOS friendly diet, as these help to increase a protein called sex hormone binding globulin which binds to excess androgens.
Give yourself an antioxidant boost to reduce inflammation and androgens
Antioxidants are chemicals that help to neutralise free radical damage (oxidation) which can contribute to inflammation. People living with PMOS likely need more of these helpful chemicals to reduce low grade inflammation associated with the condition and to help reduce androgens. Luckily, this is a yummy fix! Aiming for 2 servings of fruit such as kiwifruit, blueberries, blackberries, raspberries, strawberries, or passionfruit daily is a great way to get in those antioxidants.
Eat your omega-3s
Fats are important to help regulate our body temperature, absorb fat soluble nutrients such as vitamin D3, K2 and E, and make hormones. They’re also a potent source of energy (in the right amounts) to keep your body fuelled.
Omega-3’s in particular are important as they help to reduce inflammation, and studies show that they can improve symptoms of PMOS such as insulin resistance and cycle regularity. Fatty fish such as salmon, mackerel, sardines and rainbow trout are the best sources of this nutrient, but plant sources such as chia and hemp seeds are nice for a little top up throughout the week.
So, give that chia pudding recipe a go and get in your 2-3 serves of fatty fish!
Make EVOO your main fat.
Extra Virgin Olive Oil (EVOO) is the Queen of the Mediterranean diet, it’s absolutely everywhere from salad dressings, to dipping sauces, to cakes! And it’s for good reason too. EVOO is a major source of healthy fats called monounsaturated fatty acids and antioxidant vitamin E and polyphenols (including oleocanthol) which help to reduce inflammation, which we learned earlier is a factor in PMOS.
Go girl, drizzle on the good stuff and enjoy that rich extra virgin olive oil taste.
To summarise:
Whilst PMOS is a lifelong, complex condition that impacts hormones and metabolism in 1 in 8 women in Australia. Dietary strategies such as the Mediterranean diet is an evidence based approach to managing PMOS that is appropriate for many people, without the unnecessary dietary restriction. If you have recently been diagnosed with PMOS, have been trialling dietary changes to manage PMOS symptoms without success or if you have been diagnosed with other conditions alongside PMOS, please reach out to your local healthcare team for personalised assistance and advice.
By Amelia Rae
Accredited Practicing Dietitian
